Introducing and scaling up new vaccines is a critical aspect of protecting and improving health. JSI is providing technical support to expand the use of newly available vaccines both here in the U.S. and internationally. The ability to have such a wide-reaching impact is one of the things that make JSI such an interesting place to work.

The projects are taking place in the state of Massachusetts—where JSI is headquartered—and in Madagascar and Niger, in an effort to reach more young girls with the human papillomavirus (HPV) vaccine to prevent several types of cancer.

HPV affects millions and millions of people. HPV is the most common sexually transmitted infection, and an estimated 20 million people have the active virus at any time, according to WHO. While often a “hidden virus,” HPV can cause, among other things, cervical cancer in women as well as tonsil and tongue (oropharyngeal) and anal cancer in men, and genital warts in both men and women. In the United States alone, more than 3 million people seek care for HPV every year. In fact, most sexually active women and men—80%—will be infected at some point in their lives and some may be repeatedly infected.

While in the U.S., the HPV vaccine was licensed for girls in 2006, and for boys in 2009, in many other countries, the vaccine is only just being rolled out now.

These new vaccine introduction projects draw from JSI’s deep experience with immunization and new vaccine introductions and applies it to the specific Madagascar and Niger contexts, with the ultimate goal of integrating these vaccines into the routine immunization systems of the countries.

The HPV vaccine roll-out will bring challenges that differ from “traditional” vaccines: the target population is different—girls only, and starting at age 9 rather than in infancy; the vaccines are being given at schools rather than at health facilities; and the timing of the three doses is more complicated, as there is the need to coordinate the vaccination schedule with the school-year calendar.

In Madagascar and Niger, the HPV work has been launched in both a rural and an urban district to ensure each country is able to understand and address challenges related to each setting. The Ministry of Health and Family Planning is working closely with the Ministry of Education in a strategic effort to vaccinate the target population—girls between 9 and 11 years old.

In collaboration with the MOH, WHO, UNICEF, UNFPA, and local partners, JSI is documenting the overall roll-out process, fostering links to the broader maternal, newborn, child, and adolescent health systems in Madagascar and Niger, and supporting community engagement in HPV prevention. The experiences and lessons learned in these demonstration districts will inform decisions regarding nationwide roll-out of the vaccine.

To promote cross-learning, our Madagascar and Niger staff and counterparts have consulted with immunization program managers in other countries to share experiences and apply lessons.

Expanding reach in Massachusetts

In Massachusetts, JSI is supporting the state Department of Public Health which has mounted a statewide joint initiative to improve HPV vaccination rates with current immunization partners and stakeholders1.

Three HPV vaccines, given in a 3-dose series, are available in the United States: Gardasil 9, Gardasil, and Cervarix (Gardasil 9 is new and was licensed in December 2014. For additional information, go to www.cdc.gov and search for Gardasil 9). According to the U.S. Centers for Disease Control and Prevention, only 57 percent of adolescent girls and 35 percent of adolescent boys received one or more doses of HPV vaccine in 2013. The challenge to increasing HPV vaccine rates in the U.S. is less about access and more about overcoming stigma and misperceptions, which leads some parents to refuse the vaccine for their children. The focus of this CDC-funded initiative are educating providers about evidence-based strategies to improve parental acceptance and a media campaign targeting parents of adolescents.

The key message to parents is that “HPV vaccination is cancer prevention” and does not lead to increased sexual activity among young teens. Providers are being educated in how to deliver a strong recommendation to parents of both boys and girls so that vaccination rates will increase. Data supports the influential role a healthcare provider’s recommendation plays with parents’ acceptance.

This Department of Public Health initiative aims to ensure that Massachusetts reaches the Healthy People 2020 goal of 80 percent of female and male adolescents in the state receiving three doses of HPV vaccine by 15 years of age, regardless of race, ethnicity, or socioeconomic status.

Given the dramatic toll that HPV takes on both women and men—and that nearly all cases of cervical cancer can be attributed to HPV infection, with more than 270,000 women around the world dying from cervical cancer annually, finding ways to scale-up vaccination rates where the vaccine exists or effectively introduce it in new areas is crucial.

Whether in the U.S. or in less-developed countries, introducing new vaccines requires a comprehensive effort to inform the public, develop the supply chain systems, and train providers to both counsel about the new vaccine and deliver it to clients. JSI is working hand-in-hand with our partners to ensure that all these steps are effectively implemented to achieve the goals of safely introducing, as well as scaling up, this life-saving product.

1 Partners in Massachusetts include the Massachusetts Chapter of the American Academy of Pediatrics and the Massachusetts League of Community Health Centers —as well as new partners such as the Dana Farber Cancer Institute, Massachusetts PTA, Boston Public Health Commission, and Team Maureen, a cervical cancer advocacy group.